The proposed career development award is designed to support the transition of Dr. Aimee O. Hersh into an independent physician-scientist dedicated to improving outcomes for patients with juvenile idiopathic arthritis (JIA). Dr. Hersh is a pediatric rheumatologist at the University of Utah. She has prior training in health services research and has focused her research career on understanding the adult outcomes of childhood-onset rheumatic disease. This award would allow Dr. Hersh to complete a unique study of the natural history of JIA, as well as to describe the relationship between JIA genotype and disease phenotype. To achieve this, Dr. Hersh's career development plan is to gain advanced methodological skills in outcomes research, and to obtain training in the genetic contribution to disease and outcomes through completion of the Certificate Program in Personalized Health Care at the University of Utah. Dr. Hersh's mentoring team is led by Drs. John Bohnsack and Sampath Prahalad, pediatric rheumatologists with expertise in the outcomes of juvenile idiopathic arthritis and the genetic determinants of this condition. Additionally, she has assembled a multidisciplinary advisory team with expertise in population and genetic epidemiology, including the genetics of complex autoimmune disease, as well as the outcomes of JIA, including the measurement of disability and quality of life for patients with arthritis. Dr. Hersh's overarching career goal is to determine the biologic/genetic and non-biologic predictors of long- terms outcomes of patients with childhood-onset rheumatic disease, and to improve outcomes for this patient population. Her short-term career goal is to become an expert in the area of adult-outcomes of juvenile idiopathic arthritis, including the relationship between genetic susceptibility and outcomes. Dr. Hersh's long-term career goal is to become a successful physician-scientist who will: 1. Be a principal investigator able to lead and collaborate with multidisciplinary teams of researchers to develop the best methodology to measure adult outcomes for patients with childhood-onset rheumatic disease and other pediatric-onset chronic illnesses. 2. Be a national expert and leader designing interventions to improve outcomes for patients with childhood-onset rheumatic disease. 3. Be a mentor for junior investigators across various disciplines. Environment: The University of Utah has several unique resources which Dr. Hersh will utilize for her research proposal and training, including the Intermountain States Database of Childhood Rheumatic Diseases (ISDCRD) and the Utah Population Database (UPDB). She will gain essential research skills through completion of the Certificate Program in Personalized Healthcare. The University of Utah and Department of Pediatrics have outstanding resources dedicated to mentorship and early career development and training in clinical research, including the University's Center for Clinical and Translational Science, the NIH-funded training program in translational and comparative-effectiveness research and a Pediatric Clinical and Translational Scholars Program. Dr. Hersh currently has 75% protected time which will be ensured throughout the award period to utilize these resources in achieving her career development goals. Research: Dr. Hersh's research proposal incorporates three related research projects focused on describing the long-term outcomes of JIA. Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disease; the majority of children with JIA have persistent arthritis into adulthood. JIA is associated with premature morbidities including joint damage, growth impairment, cardiovascular disease and mortality; yet, little is known about the long-term outcomes of this chronic rheumatic disease. The central hypothesis of this proposal is that there are non-modifiable (eg. genetic) and modifiable (eg, treatment, behavioral) risk factors that, if identified, lead to targets for improvd treatment and outcomes for children with JIA. In Aim 1, Dr. Hersh will link the ISDCRD to the UPDB to examine important outcomes of JIA including the incidence of orthopedic procedures, cardiovascular events and malignancy as well as risk of infertility and early mortality. In Aim 2, she will develop a longitudinal cohort of adult patients with JIA to characterize disability and quality of life outcomes for this cohort, as well as predictors for these outcomes. In Aim 3, she will explore the relationship between genetic susceptibility loci and response to treatment in JIA. Preliminary data from this research will be used to develop interventions to improve health outcomes for patients with childhood-onset rheumatic disease. This proposal is designed to facilitate Dr. Hersh's career as an independent investigator devoted to improving care for pediatric patients with a chronic rheumatic disease.